Download Growing a Practice with M22 - Clarion Medical Technologies

Growing a Practice
with the Lumenis M22:
A Case Study with Dore Gilbert, MD
M22
Newport Dermatology and Laser Associates:
•
1 dermatologist
•
1 Physician’s Assistant
•
22 Staff Members
•
50/50 cosmetic/regular dermatology
•
150 photofacial clients per month
Over $1.8 billion dollars were spent on non-surgical skin
rejuvenation procedures in the United States in 2012, with
Intense Pulsed Light (IPL) quickly becoming one of the
most popular treatment methods due to the broad range
of effects/options. The wide range of wavelengths allows
treatment of multiple components of photoaging including
fine rhytides, telangiectasia, pigmented lesions, piokiloderma,
actinic keratosis and scar modification.
Located in Newport Beach, CA, my patient population has a
lot of exposure to the sun, both due to work and recreation.
Accordingly, we see a lot of patients with sun-related
pigmentary disorders such as telangiectases and rosacea
associated with chronic photo damage. Over the last 15
years, we have performed over 35,000 photofacials using
the IPL application on the M22 and former IPL systems by
Lumenis (San José, CA). Photo-rejuvenation is a mainstay in
my practice, providing a quality service for my patients and a
recurring revenue stream for my practice.
There are other multi-application platforms on the market,
but the M22 is the gold standard to which all others attempt
to match up. The M22 combines three technologies in one
platform, Intense Pulsed Light (IPL), ResurFX non-ablative
fractional skin resurfacing and Nd:YAG Laser, enabling
its indication for over 30 different treatments. Having one
device with a modular design is incredibly efficient. It takes
less space within the practice, saves time with combined
treatments and decreases capital expenditures on
equipment. Some primary features include:
1. Limited handpieces. With only the Universal IPL handpiece
and one other, using the M22 is uncomplicated. Rather
than storing, searching for and switching out numerous
handpieces, 6 ExpertFilters can be changed in seconds to
allow the treatment to be tailored to the condition. In the bestcase alternative, nurses and technicians lose time locating
distinct applicators and switching them, lowering the overall
number of treatments that can be performed in a day. In the
worst-case, patients are sent away and asked to schedule
the second treatment separately, increasing the possibility
that they do not return and the practice loses revenue.
2. Optimal Pulse Technology (OPT) and Multiple Sequential
Pulsing (MSP). OPT allows the delivery of both low and
high fluences over the entire range of both short and long
pulses, controlling the IPL pulse shape, and MSP controls the
delivery. For example, 18 joules of energy can be delivered in
a single pulse, or divided equally between multiple pulses. If I
choose two pulses, the energy will be equally distributed into
two pulses of 9 joules of energy each. This uniform delivery is
unique, as with most systems the first pulses is the strongest
and the energy decreases with each succeeding pulse. By
lowering the fluence of the individual pulses, the treatment is
gentler, more comfortable, and more patient-friendly.
3. Presets. I spent quite a bit of time when the M22 first came
out, helping Lumenis establish the wide variety of presets.
Skin type, targeted treatment, depth of lesion and other
specific patient data are input into the device, and the safest,
most efficient treatment parameters are generated. The user
remains in control, able to change the parameters at any time
during the treatment, as their professional judgment deems
necessary. While I initially spent quite a bit of time training all
of my nurses, the presets definitely increase the comfort and
ease with which I delegate to my staff.
Applications
Reason for Photofacials
Vascular Issues
40%
60%
Sun-related
Pigmentary Problems
Figure 1. Over half of Dr. Gilbert’s photofacial patients need treatment for a vascular
issue such as rosacea or telangiectasias.
The majority (60%) of IPL treatments performed in our
practice are for vascular problems such as telangiectasias
and rosacea. Generalized redness of the skin is treated with
the IPL module on the M22, and localized, larger veins on
face or other areas are treated with the Nd:YAG module.
The other 40% of IPL treatments are dedicated to pigmentary
problems, such as pigmented lesions, solar lentigines,
melasma, etc. While we see an extraordinary number of
photofacial clients monthly, I estimate that practices in other
areas of the country average around 20 photofacial patients
per month. Our photofacial clients have been returning for
maintenance treatments for over 10 years, and approximately
half of our photofacial appointments each month are
maintenance visits, while the remaining are new patients.
Patrick Bitter, MD, who coined the term “photofacial,”
reported that in patients he treated for 10 years, blinded
judges could not tell that they had aged. I have seen the
same results with my patients. Their skin is obviously more
luminescent, and patients are so pleased that they become a
renewing source of revenue.
IPL treatments for rosacea remain a large and
non-penetrated market. This is likely due to lack of insurance
coverage for IPL treatment of rosacea, in spite of the fact that
it is one of the most simple and successful therapies. Medical
therapy is the standard of care, but as the disease process
is vascular in nature, lasers can be an excellent adjunct to
treatment. IPL targets blood vessels and capillaries and
reduces the redness associated with the disease. It can also
be very effective with patients whose rosacea is controlled,
but are left with pigmentary issues. Due to my large patient
base and long-standing community reputation, I see rosacea
patients daily. The M22 offers a square pulse, which has a
lower, more balanced energy emission, enhancing the safety
of the treatment. Those that suffer from the disease and are
financially able, pay for IPL because it works.2,3
Revenue Generated
Procedure
# of treatments/month
Price
1 Month
1 Year
5 Years
IPL - Vascular Issues
12
$381.00
$4,572.00
$54,864.00
$274,320.00
IPL - Other Pigmentary Issues
8
$381.00
$3,048.00
$36,576.00
$182,880.00
TOTAL:
20
$7,620.00
$91,440.00
$457,200.00
Figure 2. Based on ASAPS National Average of $381/IPL treatments and Dr. Gilbert’s assumed 20 treatment monthly average.
$7,620 = Average Monthly Revenue from IPL, $3,810 from returning patients.
Combined Treatments
Photofacial with IPL is a straight-forward procedure, which
doesn’t result in any peeling and only three hours of down
time. This makes it an excellent entry-level procedure for
many people, and once a patient is in my office, it is up to my
team to make them aware of other services that might benefit
them. Internal marketing is very important and we use formal
questionnaires, in-office advertisements and pamphlets, and
simple discussions with doctors or staff.
For patients with fine lines and wrinkles in addition to rosacea
or other “red” skin disorders, I offer patients a combination of
resurfacing and photofacial. I first perform resurfacing with
UltraPulse DeepFX, which puts deeper holes in the skin in a
less dense pattern. I then comeback with ActiveFX, which is
more superficial but places target spots closer together. The
deeper treatment addresses the wrinkles with the superficial
treatment addresses the skin irregularities. I then follow-up with
IPL to remove any rosacea, telangiectasia or other pigmentary
issues.
Combining IPL with an injectable filler or toxin can enhance
rejuvenation of the face and provide patients with immediate
results, without necessitating any down time for the patient.
When I am combining IPL with an injection, I first perform IPL
treatment and then follow with the filler or toxin. This ensures
that the heat from the IPL treatment does not diffuse the
product that has been injected, diminishing its effect.
One of the advantages of IPL is that it can be combined with
anything, making it a true staple in a dermatologist’s office. The
M22 is the gold standard for the treatment of skin conditions
and hair removal because it enables you to treat more types of
patients and more conditions, always with the best outcomes.
Our patient satisfaction is outstanding, represented by the high
number of return patients and patient referrals that we receive,
which eliminates the need for any external marketing on our
behalf.
Telangiectasia
Before Treatments
After 4 Treatments
Rosacea
Before Treatments
After 4 Treatments
Lentigines
Before Treatments
After 1 Treatments
Spider Veins
Before Treatments
After 2 Treatments
Dyschromia
Before Treatments
After 4 Treatments
Freckles
Before Treatments
After 4 Treatments
Hair Removal
References
1 American Society for Aesthetic Plastic Surgery. Cosmetic Surgery National Data Bank
Statistics 2012. | 2 Taub, AF. “Treatment of rosacea with intense pulsed light.” Journal of Drugs in
Dermatology. 2003 Jun;2(3):254-9. | 3 Mark KA et al. “Objective and quantitative improvement of
rosacea-associated erythema after intense pulsed light treatment.” Dermatologic Surgery. 2003
Jun;20(6):600-4.
Before Treatments
* Photos courtesy of Mariela Nazar, MD
PB-1002840 Rev A
After 6 Treatments